Texas 2009 - 81st Regular

Texas Senate Bill SB1252 Compare Versions

Only one version of the bill is available at this time.

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1	1	81R8199 KLA-D
2	2	By: Zaffirini S.B. No. 1252
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to improving application and eligibility determination
8	8	processes and efficiencies for certain benefits programs.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Subchapter B, Chapter 531, Government Code, is
11	11	amended by adding Section 531.0992 to read as follows:
12	12	Sec. 531.0992. COMMUNITY OUTREACH FOR BENEFITS PROGRAMS.
13	13	(a) In this section, "benefits program" includes:
14	14	(1) the child health plan program;
15	15	(2) the financial assistance program under Chapter 31,
16	16	Human Resources Code;
17	17	(3) the medical assistance program under Chapter 32,
18	18	Human Resources Code, including long-term care services provided
19	19	under the program; and
20	20	(4) the food stamp program under Chapter 33, Human
21	21	Resources Code.
22	22	(b) The commission shall improve the effectiveness of
23	23	community outreach efforts with respect to benefits programs. To
24	24	improve that effectiveness, the commission shall:
25	25	(1) increase the capacity of existing outreach efforts
26	26	implemented through community-based organizations by providing
27	27	those organizations with adequate resources to:
28	28	(A) educate the public about benefits programs;
29	29	(B) provide assistance to the public in
30	30	completing applications for eligibility or recertification of
31	31	eligibility and obtaining required documentation for applications;
32	32	and
33	33	(C) assist applicants in resolving problems
34	34	encountered during the eligibility determination process; and
35	35	(2) establish a partnership with stakeholders who will
36	36	provide outreach and application assistance by:
37	37	(A) fostering the exchange of information
38	38	regarding, and promoting, best practices for obtaining health
39	39	benefits coverage for children;
40	40	(B) assisting the commission in designing and
41	41	implementing processes to reduce procedural denials under Section
42	42	531.474; and
43	43	(C) disseminating successful outreach models
44	44	across this state under which entities such as hospitals, school
45	45	districts, and local businesses partner to identify children
46	46	without health benefits coverage.
47	47	(c) The partnership established under Subsection (b)(2)
48	48	must include entities that contract with the commission to perform
49	49	child health plan and medical assistance program eligibility
50	50	determination and enrollment functions, community-based
51	51	organizations that contract with the commission, health benefit
52	52	plan providers, Texas Health Steps program contractors, health care
53	53	providers, consumer advocates, and other interested stakeholders.
54	54	(d) The commission may also improve the effectiveness of
55	55	community outreach efforts with respect to benefits programs by
56	56	contracting with one or more persons to provide outreach and
57	57	application assistance for the programs. The commission shall
58	58	require each potential contractor under this subsection to indicate
59	59	the person's interest in writing before submitting a proposal for a
60	60	contract. If more than one person from a geographic area determined
61	61	by the commission submits a letter of interest, the commission
62	62	shall encourage the persons from that area to collaborate on a
63	63	proposal for a contract.
64	64	(e) To the extent practicable, the commission shall give
65	65	preference in awarding contracts under Subsection (d) to proposals
66	66	submitted by collaborations that include multiple entities with
67	67	experience in serving a variety of populations, including
68	68	populations that more commonly enroll in or receive benefits under
69	69	benefits programs.
70	70	SECTION 2. Chapter 531, Government Code, is amended by
71	71	adding Subchapter M-1 to read as follows:
72	72	SUBCHAPTER M-1. ELIGIBILITY DETERMINATION STREAMLINING
73	73	AND IMPROVEMENT
74	74	Sec. 531.471. DEFINITIONS. In this subchapter:
75	75	(1) "Benefits program" includes:
76	76	(A) the child health plan program;
77	77	(B) the financial assistance program under
78	78	Chapter 31, Human Resources Code;
79	79	(C) the medical assistance program under Chapter
80	80	32, Human Resources Code, including long-term care services
81	81	provided under the program; and
82	82	(D) the food stamp program under Chapter 33,
83	83	Human Resources Code.
84	84	(2) "SAVERR" means the System of Application,
85	85	Verification, Eligibility, Referral, and Reporting.
86	86	(3) "TIERS" means the Texas Integrated Eligibility
87	87	Redesign System.
88	88	Sec. 531.472. APPLICATION PROCESSING STANDARDS AND
89	89	PROCEDURES. (a) The executive commissioner by rule shall adopt for
90	90	benefits programs:
91	91	(1) a methodology for establishing minimum levels of
92	92	eligibility determination staff, qualifications for that staff,
93	93	and the maximum caseload per staff person, that will ensure that:
94	94	(A) benefits program eligibility determinations
95	95	are made within applicable processing time requirements
96	96	established by state and federal law and are accurately made; and
97	97	(B) case appeals and enrollee recipient
98	98	information changes are timely processed; and
99	99	(2) in addition to streamlined administrative
100	100	processes implemented under Section 531.02411, eligibility
101	101	determination procedures that enhance efficiencies and eliminate
102	102	unnecessary administrative requirements in making those
103	103	determinations.
104	104	(b) In adopting the methodology and procedures required by
105	105	Subsection (a), the executive commissioner must ensure that it is
106	106	feasible, under both SAVERR and TIERS, evaluated separately, to
107	107	achieve a goal of processing at least 95 percent of the applications
108	108	and eligibility recertifications for benefits programs within the
109	109	applicable processing time requirements established by state and
110	110	federal law.
111	111	(c) The methodology for establishing staffing levels and
112	112	staff qualifications and maximum caseloads adopted under
113	113	Subsection (a) must apply with respect to all eligibility
114	114	determination staff persons, regardless of whether those persons
115	115	are state employees, contractors, or contractors' employees.
116	116	Sec. 531.473. CORRECTIVE ACTION PLAN. (a) The executive
117	117	commissioner shall develop and implement a corrective action plan
118	118	for application and eligibility recertification determination
119	119	processes for benefits programs if, for three consecutive months:
120	120	(1) less than 90 percent of the applications or
121	121	eligibility recertifications for benefits programs are accurately
122	122	processed through SAVERR within the applicable processing time
123	123	requirements established by state and federal law; or
124	124	(2) less than 90 percent of the applications or
125	125	eligibility recertifications for benefits programs are accurately
126	126	processed through TIERS within the applicable processing time
127	127	requirements established by state and federal law.
128	128	(b) A corrective action plan:
129	129	(1) must require the implementation of changes
130	130	specifically designed to target the processing time or accuracy
131	131	factors that required the implementation of the plan, which may
132	132	include implementing changes with respect to contractors or changes
133	133	to address TIERS defects or staff training; and
134	134	(2) may authorize the commission to take necessary
135	135	actions to hire additional eligibility determination staff,
136	136	including requesting that the Legislative Budget Board take action
137	137	as provided by Chapter 317 to make money available for that purpose.
138	138	Sec. 531.474. REDUCTION OF PROCEDURAL DENIALS. (a) In this
139	139	section, "procedural denial" includes:
140	140	(1) a denial of eligibility solely because information
141	141	is missing from an application; and
142	142	(2) an automatic denial of eligibility because an
143	143	enrollee or recipient, the parent or legal guardian of an enrollee
144	144	or recipient, or an eligibility determination staff person or
145	145	contractor fails to take necessary actions for recertification of
146	146	eligibility.
147	147	(b) In consultation with the partnership with stakeholders
148	148	established under Section 531.0992, the executive commissioner
149	149	shall adopt, and the commission shall implement, processes designed
150	150	to reduce to the lowest practicable level the incidence of
151	151	procedural denials of eligibility for benefits programs.
152	152	(c) Processes adopted under Subsection (b) may include:
153	153	(1) providing specific instructions to applicants,
154	154	enrollees, and recipients, or their parents or legal guardians,
155	155	regarding acceptable documentation of income for purposes of an
156	156	eligibility determination, including instructions for documenting
157	157	income from part-time employment, contract employment, and income
158	158	paid in cash or by personal check;
159	159	(2) contacting by telephone enrollees and recipients,
160	160	or the parents and legal guardians of enrollees and recipients, who
161	161	do not complete required forms for recertification of eligibility;
162	162	and
163	163	(3) allowing an applicant, enrollee, or recipient, or
164	164	the parent or legal guardian of an applicant, enrollee, or
165	165	recipient, a period to provide information that is missing from an
166	166	application for an initial determination or recertification of
167	167	eligibility and the lack of which would otherwise cause a
168	168	procedural denial, instead of requiring the person to submit a new
169	169	application.
170	170	(d) If the commission implements a telephone contact
171	171	process as described by Subsection (c)(2), the contacts may be made
172	172	by commission employees or by entities that contract with the
173	173	commission.
174	174	(e) The commission shall specify the period during which
175	175	missing information described by Subsection (c)(3) may be provided
176	176	to avoid a procedural denial. The period may not be less than 10
177	177	business days after the date an applicant, enrollee, or recipient,
178	178	or the parent or legal guardian of the applicant, enrollee, or
179	179	recipient, is notified that the information is missing.
180	180	Sec. 531.475. CALL RESOLUTION STANDARDS. (a) The
181	181	executive commissioner by rule shall adopt:
182	182	(1) telephone call resolution standards and processes
183	183	for each call center established under Section 531.063, including a
184	184	call center operated by a contractor, to increase the percentage of
185	185	telephone calls regarding questions, issues, or complaints
186	186	received at call centers that are successfully resolved; and
187	187	(2) a process for receiving and resolving issues and
188	188	complaints from a person who applies for an initial determination
189	189	or recertification of eligibility for a benefits program,
190	190	regardless of whether the person applied through a call center, a
191	191	local eligibility determination office, or mail correspondence.
192	192	(b) Standards adopted under Subsection (a)(1) must specify
193	193	the criteria by which the resolution of a telephone call received at
194	194	a call center will be evaluated. The criteria may include hold
195	195	times and call abandonment rates, but must include additional
196	196	measures the executive commissioner determines appropriate.
197	197	(c) To be considered for a contract to operate a call center
198	198	under Section 531.063, a person must include in the proposal for the
199	199	contract a specific description of the means by which the person
200	200	will ensure compliance with the standards adopted under Subsection
201	201	(a)(1) if awarded the contract. Each contract entered into by the
202	202	commission and a person to operate a call center must include terms
203	203	regarding the means by which the contractor will ensure that
204	204	compliance.
205	205	SECTION 3. Effective September 1, 2009, Section 32.0261,
206	206	Human Resources Code, is amended to read as follows:
207	207	Sec. 32.0261. CONTINUOUS ELIGIBILITY. The department
208	208	shall adopt rules in accordance with 42 U.S.C. Section
209	209	1396a(e)(12), as amended, to provide for a period of continuous
210	210	eligibility for a child under 19 years of age who is determined to
211	211	be eligible for medical assistance under this chapter. The rules
212	212	shall provide that the child remains eligible for medical
213	213	assistance, without additional review by the department and
214	214	regardless of changes in the child's resources or income, until the
215	215	earlier of:
216	216	(1) the first anniversary of [end of the six-month
217	217	period following] the date on which the child's eligibility was
218	218	determined; or
219	219	(2) the child's 19th birthday.
220	220	SECTION 4. Section 531.475(c), Government Code, as added by
221	221	this Act, applies to a proposal for a contract for the operation of
222	222	a call center submitted, and a contract for the operation of a call
223	223	center entered into or renewed, on or after September 1, 2009. A
224	224	proposal for a contract submitted, or a contract entered into or
225	225	renewed, before that date is governed by the law in effect on the
226	226	date the proposal was submitted or the contract was entered into or
227	227	renewed, and the former law is continued in effect for that purpose.
228	228	SECTION 5. If before implementing any provision of this Act
229	229	a state agency determines that a waiver or authorization from a
230	230	federal agency is necessary for implementation of that provision,
231	231	the agency affected by the provision shall request the waiver or
232	232	authorization and may delay implementing that provision until the
233	233	waiver or authorization is granted.
234	234	SECTION 6. This Act takes effect immediately if it receives
235	235	a vote of two-thirds of all the members elected to each house, as
236	236	provided by Section 39, Article III, Texas Constitution. If this
237	237	Act does not receive the vote necessary for immediate effect, this
238	238	Act takes effect September 1, 2009.